BACKGROUND
[0001] This safety-stop trochar device and system relates to an improvement in safety features
for trochar assemblies [also referred to as trochar], and more particularly to a safety-stop,
attachable to a trochar, registerable on a trochar, used on a trochar to permit puncture-movement
of the trochar only to a pre-determined and pre-set depth, and interchangeability
and concurrent or separate use of individual components therewith. These components
include, but are not limited to, a drainage tube, a smoke evacuator, an obturator,
and an illumination device each of which are adapted to be held securely in place
during the course of a surgical procedure and thereafter as necessary or desired.
[0002] A trochar is sharp-pointed surgical instrument basically comprised of a stylet [the
sharp cutting blades] and a cannula [a small tube for insertion into a body cavity
or into a duct or vessel; also referred to herein as trochar tube or a sleeve] and
is typically utilized to puncture a body cavity. The stylet is removably housed in
the cannula and after the body cavity is punctured, the stylet is removed leaving
the cannula in place and in communication with the body cavity whereby endoscopic,
and similar, instruments can then be inserted through the cannula and into the body
cavity.
[0003] Specific forms of minimally invasive surgical procedures include endoscopic and laparoscopic
surgery which typically involve using small incisions and optical instrumentation
being inserted into the body cavity. Endoscopy refers to video-assisted surgery that
is performed through several small incisions rather than a single large incision.
Laparoscopy is endoscopy that is done in the abdominal cavity.
[0004] The primary instrument used for the incisions necessary in these procedures is the
trochar. The use of the trochar for these procedures greatly reduces the amount of
cutting required in the course of surgery and, concomitantly, reduction of stress
to the body. Reduction of stress to the body generally leads to faster recoveries
and lower medical costs. Great care, however, must be exercised when performing such
body cavity punctures with the trochar as the trochar blades are 'surgically' sharp
and the exertion of manual force is required for the blades to pierce and go through
the skin and abdominal wall of the patient.
[0005] A primary purpose of our safety-stop trochar device and system is to prevent the
sharp trochar blades from accidentally being inserted too deeply. The inherent act
of inserting the trochar and attempting to place it where desired requires applying
a great deal of initial force down toward the deep anatomic structures, without being
able to visualize them, then by sensing a loss of resistance, discontinuing the thrust.
[0006] All of this is generally done within a fraction of a second. Patient tissue-variability,
in thickness and strength, further complicates the estimation of how much force is
required, and for how long, to attain safe penetration.
[0007] Excess force, however minimal, or unforeseen factors within the body cavity could
lead to piercing or cutting internal organs or other internal structures which could
lead to inadvertent and severe life-threatening surgical complications. It has been
known that some surgeons extend and use their finger, placed along the sleeve of the
trochar, as a makeshift stop. This is awkward, inaccurate, and dangerous.
[0008] Trochars manufactured with shielded tips covering the blades;
i.e., a safety shield, provide some aid in preventing inadvertent second cuts. While shielded
trochar systems vary in their design, all generally have a spring-loaded retractable
shield that covers the cutting tip on the blades of the trochar. The shields are either
retracted prior to placement of the trochar in the wound or automatically retract
during the placement. Once the sharp tip of the trochar's blades penetrates an abdominal
wall and enters the abdominal cavity, the spring-loaded safety shield automatically
deploys, covering the cutting tip and locking in place.
[0009] Theoretically, this prevents or decreases the incidence of damage to the bowel and
the major vessels. Injuries can still occur, however, if the trochar is not used properly,
if there is a malfunction of the safety shield, or with the presence of bowel adhesions
to the anterior abdominal wall. Even with this improvement to the trochar, insertion
of the primary trochar blades still remains a blind procedure.
[0010] Laparoscopy is a very commonly performed procedure throughout the world. In the U.S.
alone, some 6 million cases are performed annually. The total number of cases is growing,
as more specialties (general surgery, urology, gynecology) convert procedures over
to the laparoscopic approach. Notwithstanding the safety features developed over the
years for the trochar, laparoscopy has a background serious complication rate of approximately
three to five per 1,000, due to trochar placement. These include intestinal damage,
bladder damage, and most seriously large blood vessel (vascular) injury. Of the vascular
injuries, which stand at one to two per 1,000, approximately 23% will die.
[0011] The majority of serious injuries occur when the stylet of the trochar, with cannula
attached, is inserted too deeply, damaging the deeper structures within the body.
Only 5 cm. maximum length is necessary, to enter the peritoneal cavity at the umbilicus,
the most common entry site. However, trochars are 12 to 15 cm. in length, as a one
size-fits-all device. The deep structures, most significantly major blood vessels,
can be damaged at 7 to 10 cm., depending on the size of the patient, the degree of
gas insufflation raising the abdominal wall, and the angle of thrust executed by the
health-care provider.
[0012] Our safety-stop trochar device and system will function to reduce injuries and deaths
to patients undergoing laparoscopic surgery. It will aid the health-care provider
during the surgical procedure after one or more trochar incisions for internal surgery
are made by:
- a. applying a smoke evacuator to yet another of our safety-stop trochar device and
system to remove smoke from the cavity which, in many laser and electro-surgical procedures,
generate smoke and thereby obstructs the surgeon's vision;
- b. applying a drainage tube to another of our safety-stop trochar devices and systems
to effect drainage of fluids from the peritoneal cavity for post-operative evacuation
of fluids;
- c. applying a obturator to any one of our safety-stop trochar devices and systems
after completion of surgery to thereby leave an incision unhealed and permit access
into the cavity for viewing of post-operative results without the need to make another
trochar incision or to force entry into the cavity from a closed and partially healed
prior incision;
- d. applying an illumination device to one of our safety-stop trochar device and system
and into the cavity upon which surgery is being performed to provide much need full
lighting of the peritoneal cavity to the surgeon;
- e. inclusion of an adhesive on the underside of the base; and
- f. addition of U-shaped extensions on the cap to facilitate securing to the base.
[0013] During Laparoscopic surgery the surgeon is often called upon to use electro-surgical
instruments for cutting and/or cauterizing inside the peritoneal cavity. Because these
instruments are essentially burning the flesh, they create a great deal of smoke that
limits the already limited visibility a surgeon has when viewing the procedure through
a laparoscope. Now, a shortened smoke evacuator cannula can be placed through a trochar
and secured by our safety-stop device/trochar system [base 110, insert 140, and cap
130] in place. This would be like maintaining a vacuum hood over a range while cooking,
which can be activated periodically. Current technology typically requires a smoke
evacuator to be grasped, fed through the trochar, activated, removed from the cannula,
and replaced where it won't fall off the surgical field. This process is repeated
numerous times throughout the surgical procedure.
[0014] This entire new system to include a smoke evacuator is designed to allow the surgeon
a hands-free way to evacuate smoke from the peritoneal cavity during surgery using
the safety-stop trochar device/system as a platform. Anything that can be done to
improve this view has the potential of shortening the surgical procedure, saving operating
room time (saving money) and saving lives. The current method of evacuating smoke
from the peritoneal cavity is to have an additional set of hands holding the tube
in a spot dictated by the surgeon. The smoke evacuator of our present inventive system
will eliminate the need for this costly person.
[0015] The addition of a drain holder [in conjunction with an insert of approximately ±
3MM) was also fashioned into this complete system. Many surgeries entail placement
of drains, usually hollow Jackson-Pratt type drains, to remove accumulating blood
or pus or serious drainage over the critical one to four day post-operative period.
These drains generally are sutured to the skin, which is NOT ideal when infection
and pus are present, as is often the case. Our safety-stop device and entire new system,
with the adhesive base, can secure the drains more optimally and provides a secure
base to which a drainage tube can be attached. It requires only that the safety-stop
trochar device/system be provided with one 1-2 additional inserts to fit the common
sizes of drainage tubes.
[0016] The current method of attaching a drainage tube is insecure and often un-sterile
and can be accidentally pulled out. Many complications occur because sutures have
to be placed in an area of the body that may be contaminated by pus. For aesthetic
reasons, many patients find suture scars undesirable. The Adhesive back of the safety-stop
trochar device/system flange provides a secure platform for inserting the drainage
tube and eliminates the need for stitches when holding it in place. Our original safety-stop
device, in itself is a unique device and the drainage tube holder is designed to supplement
it, as a complete system in a way that makes it even more unique in it's design and
overall function.
[0017] When performing laparoscopic surgeries, up to five trochars can be used to make incisions
in the lap for the laparoscope or any of the surgical instruments. It is often desirable
to have a "second look" within hours to days after the initial surgery is performed.
The purpose of these second looks is to re-enter and check for correct healing, possible
infections, proper drainage of the abdominal cavity and other post-operative complications.
The current method of taking these second looks is re-enter one of the ports into
the lap that were made during the initial surgery by removing the stitches that were
used to close the incision. This requires an un-stitching and mechanical re-opening
of the incision which may have already partially healed. Surgeons have indicated a
need to have an easier way to re-enter the original incision made by the trochar for
a second look.
[0018] This sterile obturator, placed through a laparoscopic port incision, and secured
by a safety-stop trochar device/system, allows maintaining a laparoscopic port. Indications
may include expected re-operation in one to three days, or irrigation of an intra-abdominal
or pelvic abscess. During the period between the initial surgery and the second look,
the incision may begin to heal and is often partly closed when the surgeon removes
the stitches.
[0019] The inclusion of an obturator in the present system provides a method by which an
it can be inserted into the peritoneal cavity with relative ease and as unintrusively
as possible. It can be made of any plastic, thermoplastic, rubber, metal, urethane
or polymer and can be installed in less than a minute permitting easy entry for the
surgeon to place a scope for a second look and obviates the need for stitching and
un-stitching the incision which is partially healed. It does not impede performance
of the remainder of the surgery.
[0020] When performing laparoscopic surgeries, the peritoneal cavity in insufflated with
gas creating a balloon-like dome in the peritoneal cavity in which to operate. Currently
lighting for laparoscopic surgery is quite rudimentary. Typically the surgeon dedicates
one hand to pointing the light on a scope at a particular object he/she wishes to
see. This is like shining a flashlight in an empty room and only seeing the desk or
like entering a room with a flash light without full overhead lighting when it is
preferable to turn on the overhead light and see everything.
[0021] The addition of an illumination device into the present safety-stop trochar device/system
greatly facilitates the vision for a surgeon. The illumination device can be a short
light, such as a LED light or any conventional fiber optic light, to illuminate the
peritoneal cavity. This would be either placed through a short trochar, or passed
through the surgical port site, after the trochar created the opening, and was removed.
This could create greater, more uniform illumination of the surgical field, with all
the associated benefits of accuracy, decreased surgeon fatigue and less shadowing.
Also, the heavy fiber optic light cord could be eliminated, and a better laparoscope
could evolve, which did not include a light channel running through it, which sacrifices
camera lens space and capacity.
[0022] This illumination concept was primarily designed to allow the surgeon a hands free
way to illuminate the entire peritoneal cavity through the use of a corded or battery
powered light that uses the safety-stop trochar device/system as a platform.
[0023] Our safety-stop trochar device and system can be made of any material though, for
cost considerations, any form of plastic or, particularly for the base wings, pliant
plastic is best suited in that the wings should be flexible. Furthermore it can, but
need not, be disposable for further patient safety as a one-time use.
[0024] The base wings [or extensions] of our safety-stop trochar device acts as a base support
and each base wing has at least one aperture adjacent to the ends of the wings. The
purpose of this structure is to permit the user to secure the base to the patient
by suturing the base to the patient through the apertures on the wings. This more
effectively and efficiently secures the base to the patient thereby freeing up the
user's hand by not requiring the user to steadily hold the base onto the patient without
movement; a difficult position to maintain.
[0025] An adhesive substance on the bottom of the base wings is included to thereby permit
a user to merely clean a patient's skin and directly apply the base to the skin. The
adhesive secures the base to the skin without need of suturing.
[0026] The flexible base allows the correspondingly inserted trochar a full range of motion,
restriction that a rigid base may impose. The flexible base, in combination with the
addition of an adhesive base presents a more useful and adaptive device. Securing
the safety-stop trochar device/system to the patient eliminates trochar dislodgement,
which frequently occurs with instrument exchanges, and which frequently leads to loss
of the CO2 gas which is holding up the anterior abdominal wall. This is a significant
setback to surgical progress, and has some risk in addition to the inconvenience.
The adhesive base allows another non-invasive option, in addition to suturing, to
secure the safety-stop trochar device/system to the patient.
[0027] Although the base wings may be comprised of any material but, as mentioned above,
it has been found that if the base wings are rigid, in use the wings tend to cause
bruising to the patient. A thermoplastic material or a thermoplastic rubber material
is best suited for the construction of the base and the wings to ensure their flexibility.
It has been found that wing pliability also affords a user greater flexibility of
placement of the safety-stop trochar device and system and minimize, if not eliminate,
bruising a patient. Depending on where a trochar is to be used on a patient, angling
of the safety-stop trochar device and system may be necessitated. The pliability of
the base and wings, due to the materials of which they are composed, also facilitates
placement, angling, and safe and more exacting use of the safety-stop trochar device
and system and trochar attached to it.
[0028] The safety-stop trochar device and system also facilitates introduction of surgical
instruments through the tube upstanding from the base without fear of excess movement
by the user. The base, sutured to the patient or secured by the adhesive, holds fast,
without movement, facilitating the procedures to follow.
[0029] A wing-nut type concept for the cap with U-shaped protrusions extending outward from
the cap facilitates the fastening of the cap to the base. The protrusions should generally
be on opposite side of each other. This eliminates the need for an external object,
such as a wrench, to secure the cap to the base, thereby adding compression to the
insert so as to secure the device onto the cannula of the trochar. Personal experience
and anecdotal data gathered from other surgeons have led applicants to seek an alternative
method of securing the safety-stop trochar device/system without the use of a wrench
and thereby conceiving the wing nut concept. Two such protrusions as the wing nut
are ideal but three or four may also function well.
[0030] Some other unique features of our safety-stop trochar device/system include:
- a. shortening the effective length of the dangerous sharp trochar/sleeve, by gripping
the outer sleeve, with a wider diameter cuff;
- b. it can be used with any of the major trochar/sleeve manufacturers' current product-lines;
- c. it does not impede appropriate surgical trochar/sleeve entry, only inadvertent
deep entry;
- d. it does not impede performance of the remainder of the surgery;
- e. it is compatible with any other "safety-features" built into other areas of the
trochar/sleeve;
- f. it can be placed anywhere along the sleeve, to shorten the effective length, at
the surgeon's discretion, for that particular-sized patient;
- g. it does not require abandoning current surgeon preferences of trochar/sleeve;
- h. it provides a secure entry point for the introduction of surgical instruments for
use on the patient;
- i. it does not require new or further training to use;
- j. a base and wings constructed of pliable materials facilitate placement and use
of the safety-stop device, particularly in difficult-to-access areas and virtually
prevents the bruising a patient as compared to a base and wings which are more rigid;
- k. it will be inexpensive to manufacture and will not thereby add significant cost
to a surgical case;
- l. it can, and will, save lives; and
- m. it will save the health-care system millions of dollars in patient disability,
emergency rescue surgery, and malpractice exposure.
[0031] The foregoing has outlined some of the more pertinent objects, features, functions,
and uniqueness of the safety-stop trochar device and system. These objects should
be construed to be merely illustrative of some of the more prominent features and
applications of the safety-stop trochar device and system. Many other beneficial results
can be attained by applying the stop trochar device and system within the scope of
the disclosure.
[0032] Accordingly, other objects and a fuller understanding of the safety-stop trochar
device and system may be had by referring to the summary of the safety-stop trochar
device and system and the detailed description of the preferred embodiment in addition
to the scope of the safety-stop trochar device and system defined by the claims taken
in conjunction with the accompanying drawings.
[0033] US 2006/293702 A1 discloses a safety-stop trocar device and system comprising: a base having a bottom
and a circular upstanding member with an externally threaded inner chamber and a floor
therein, and at least three extension wings extending axially outward from said base;
a cap with a mid-point relative to its height, said cap having an opening therethrough
comprising a upper section opening, said cap further having internal threading; and
an insert adapted to seat onto said floor, said insert further comprising a bore therethrough.
[0034] US 5 380 302 A discloses a cannula retainer or safety-stop trocar device having a base with an internal
thread, a cap with an external thread and an insert.
SUMMARY
[0035] The above-noted problems, among others, are overcome by the safety-stop trochar device
and system, as defined in claim 1. Preferred embodiments of the invention are defined
in the dependent claims. Briefly stated, the safety-stop trochar device and system
contemplates a complete system of component parts for use with a trochar where the
main components of this system include a base, an insert, a cap, and several complimentary
surgical components such as a drainage device, a smoke evacuator [each used in conjunction
with the insert], an obturator, and an illumination device [each used without the
insert]. The main components, when involved with laparoscopic surgery are used as
a multi-purpose platform to assist the surgeon in six discreetly independent procedures
that are common to laparoscopic surgeries: controlling depth of trochar insertion,
stabilizing the trochar during instrument exchanges, providing a platform for eliminating
smoke, providing a platform for eliminating accumulated liquids/fluids [such as blood,
pus, or serious drainage] which poses a health hazard to a patient, providing a platform
for maintaining a post-operative incision in a patient for later inspections, and
providing a platform for illuminating the operating field.
[0036] The base, insert, and cap are attachable to the trochar tube to prevent inadvertent
cuts being made to a patient. Three flexible extension wings on the base and associated
adhesive on the bottom of the base permit the base to be secured to the patient without
suturing the base to the patient. Apertures in the wings provide for a suturing option
if deemed necessary or desired by the surgeon.
[0037] The cap has U-shaped extension on opposing sides of the cap wall to aid in attaching
and threading the cap to the base. An opening through the cap from top to bottom consists
of two distinct sections; an upper section which is perpendicular to the cap floor
and a lower section which is angled downward and outward toward the cap floor. This
configuration facilitates acceptance of the insert and its compression to thereby
secure external objects within the insert bore.
[0038] The foregoing has outlined the more pertinent and important features of the safety-stop
trochar device and system in order that the detailed description that follows may
be better understood so the present contributions to the art may be more fully appreciated.
Additional features of the safety-stop trochar device and system will be described
hereinafter which form the subject of the claims. It should be appreciated by those
skilled in the art that the conception and the disclosed specific embodiment may be
readily utilized as a basis for modifying or designing other structures and methods
for carrying out the same purposes of the safety-stop trochar device and system. It
also should be realized by those skilled in the art that such equivalent constructions
and methods do not depart from the scope of the safety-stop trochar device and system
as set forth in the appended claims.
BRIEF DESCRIPTION OF THE DRAWINGS
[0039] For a fuller understanding of the nature and objects of the safety-stop trochar device
and system, reference should be had to the following detailed description taken in
conjunction with the accompanying drawings in which:
Figure 1 is perspective view of a typical trochar assembly.
Figure 2 is an elevation, cross-sectional, exploded view of a first embodiment of
the safety-stop device.
Figure 3 is a plan view of the cap component of the safety-stop device as taken on
line 3-3 of Figure 2.
Figure 4 is a cross-section view of the opposite side, rotated 180°, of the insert
40 as illustrated in Figure 2.
Figure 5A is a plan view of the insert device as taken on line 5-5 of Figure 4.
Figure 5B is a plan view of the insert device showing in more detail the four upper
slots.
Figure 6 is an elevation view of a second embodiment of the safety-stop device.
Figure 7 is a cross-section elevation view of the cap illustrated in Figure 6.
Figure 8 is a plan view of a first embodiment of the base of the safety-stop device
as taken on line 8-8 of Figure 6.
Figure 9 is a perspective exploded view of a third embodiment of the safety-stop device.
Figure 10 is perspective view of a typical trochar assembly with a second embodiment
of the base of the safety-stop device.
Figure 11 is a plan view of the second embodiment of the base of the safety-stop device
as taken on line 8-8 of Figure 8.
Figure 12 is a bottom plan view of the base of Figure 11 illustrating the adhesive
on the bottom.
Figure 13, as taken on line 13-13 of Figure 14, is an exploded cut-away view of the
new safety-stop device, in accordance with the invention.
Figure 14 is a top plan view of the cap of the new safety-stop device illustrating
in detail the U-shaped extensions.
Figure 15 is a top plan view of the base.
Figures 16A and 16B are detailed views of an obturator and illumination device, respectively,
for use with the Safety-stop trochar device and system.
Figure 17 is a detailed, cut-away view of the safety-stop trochar device and system
with a drainage tube attached.
Figures 18A and 18B are detailed perspective views of inserts for use with the safety-stop
trochar device and system.
Figure 19 is a detailed perspective view of the base of the safety-stop trochar device
and system.
DETAILED DESCRIPTION
[0040] Referring now to the drawings in detail and for a more complete understanding of
the safety-stop trochar device and system of the present disclosure, reference is
hereby first made to Figures 1-11. In this regard, and in particular to Figure 1,
a typical trochar assembly 50 is illustrated. Reference character 10 of Figure 2 which
generally designates a safety-stop device in accordance with one preferred embodiment
thereof.
[0041] The trochar assembly 50 has a set of blades 58 attached to a knob 62 which, after
the trochar assembly 50 is used, is removable from the cannula 54 [trochar tube].
The cannula 54, having a width W, is attached to a head assembly 60 with its components
[reference characters 64, 66, 68] thereon. A blade shield 56 with an shield opening
52 at its far end covers the blades 58 to facilitate safe handling of the trochar
assembly 50 and to prevent accidental cuttings.
[0042] Typically once the trochar assembly 50 has been used to execute the surgical procedure,
the surgeon grasps the knob 62 and pulls the blades 58 with blade shield 56 out from
the cannula 54. The cannula 54 remains and is in communication with the body cavity
into which the trochar assembly 50 penetrated. Suitable hoses [not shown], for example,
are connected to the inlet/outlet 66 on valve 64, and the valve lever 66 is positioned
on/off [arrows A, B] to, for example, force air or gas into the patient as, and if,
necessary to the procedure.
[0043] The safety-stop device 10 has a base component 12, an insert component 40, and a
cap component 30. The base 12 has a stem 13 [upstanding member] attached thereto and
a base channel 14 which is bore completely therethrough from the bottom [point Z1]
of the base to and out of the top of the upstanding member 13 [point Z3].
[0044] The width of the channel 14 at the bottom of the base is X3-Y3. The width at the
opening on the top of the upstanding member 13 is X5-Y5. Width X5-Y5 is greater than
width X3-Y3 in that the channel 14 initiates an outward angling 14' above the bottom
of the base 14 at approximately point Z2 which bears a width X7-Y7 and terminates
at the top [point Z3] of the upstanding member 13 defining an opening thereat having
width X5-Y5 wherein width X5-Y5 is greater than width X7-Y7 and wherein width X7-Y7
could be equal to or greater than width X3-Y3. The width of the base 12 [X9-Y9] is
substantially greater than the width of the upstanding member 13 [X8-Y8]. It is this
base width [X9-Y9] which functions as a stop. The external surface of upstanding member
13 is threaded.
[0045] The insert 40, a collet-like component, is configured to fit and seat into the base
channel 14, 14' at approximately point Z2 with its exterior surface 44' bearing an
angle approximately equal to angle 14'. In this regard, the insert 40 has a height
[Z2' to Z3'] which is slightly larger than the distance from point Z2 to point Z3.
The insert 40 has a bore 44 vertically disposed therethrough [insert channel]. The
width of the insert channel 44 is X2-Y2. The width of the top of the insert 40 is
X4-Y4 and the width at the bottom of the insert 40 is X6-Y6. As the insert 40 is structured
to seat into the base channel 14, width X4-Y4 is slightly greater than width X5-Y5,
and width X6-Y6 is slightly greater than width X7-Y7.
[0046] As illustrated in Figures 2 and 4, the insert 40 may have one or more vertical slots
46A on the bottom [Figure 2] or one or more vertical slots 46B, 46D on the top or
any combinations thereof. The slots may be extend upward or downward, respectively,
partially or, as illustrated in Figure 5A and 5B, vertically extend the full distance
from top to bottom [reference character 46C].
[0047] The cap 30 has a hollow interior with threading 38 on the interior surface thereof.
The interior threading [female threading] 38 of the cap 30 corresponds with the exterior
threading 18 [male threading] of the upstanding member 13. Once the insert 40 is seated
into the upstanding member 13 and the cap 30 threaded over the upstanding member 13
a sealing, retaining, and registering unit is formed. On the top of the cap 30 is
a cap aperture 34 which has a width X1-Y1.
[0048] In this embodiment widths X1-Y1, X2-Y2, X3-Y3 are approximately equal and each are
approximately equal to or slightly greater than the trochar tube 56, width W. In operation,
there are many methods of attaching the safety-stop device 10 to the trochar assembly
50;
i.e., whether the trochar assembly 50 is inserted into the safety-stop device 10 after
the safety-stop device 10 has been assembled as a unit or before such assembly as
a unit, or whether the assembled or unassembled safety-stop device 10 is inserted
onto the trochar assembly 50, or any combinations there.
[0049] The final configuration will have the cap 30 distal from the shield opening 52 with
the threaded interior 38 facing the shield opening 52. Next is the insert 40, wider
end first, followed by the base 12 with its bottom facing the shield opening 52. The
insert 40 is seated into the upstanding member 13 and the cap 30 and the upstanding
member 13 are connected. In view of the larger size of the insert 40, this connection
causes the insert 40 to press against the cannula 54 and tighten and secure around
it. The slots 46A, 46B, 46C, depending on which configuration of insert 40 is being
used, are squeezed and close or pinch in the process. The tighter the connection between
cap 30 and base/upstanding member unit 12, 13, the more securely the safety-stop device
10 is contained on the cannula 54.
[0050] Loosening the connection between the base/upstanding member unit 12, 13, loosens
the connection between the safety-stop device 10 and the cannula 54 to thereby permit
the safety-stop device 10 to translate back and forth on the cannula 54 to any desired
point for a pre-determined depth in execution. Once that pre-determined point is established,
the safety-stop device 10 is secured to the cannula 54, the trochar assembly is ready
to use, and the base 12 acts as a stop once it contacts the skin of the patient to
prevent further penetration into the patient's body cavity.
[0051] Figures 6-8 illustrate a slightly different safety-stop device 10 configuration without
an insert 40. Here the base 12 and upstanding member 13 unit are configured externally
basically as described above. In this embodiment the upstanding member 13 has one
or more vertically disposed slots 16, no internally angled walls 14', and a width
W3-W4 at the top. The cap 30 is basically identical except that is has one or more
vertically disposed fins 32 on its exterior surface to aid the user in tightening
the cap 30 onto the base/upstanding member unit 12, 13. The threading 38 on the inside
surface is somewhat tapered in that the width W1-W2 at the top is less than width
W3-W4 at the top of the upstanding member 13.
[0052] The cap aperture 34 has a width X1-Y1 and the channel aperture 14 at the bottom of
the base 12 has a width X3-Y3. Each of these widths [X1-Y1 and X3-Y3] are equal to
or slightly greater than the trochar tube 54 width W.
[0053] As before, once the safety-stop device 10 and the trochar assembly 50 are attached,
tightening the cap 34 over the upstanding member 13, with its smaller width W1-W2,
squeezes the upstanding member 13 tightly [in the directions of Arrows D] over the
trochar tube 54. Loosening the cap 34 permits the user to slide the safety-stop device
10 to any desired location on the trochar tube 54, re-tighten the cap, and use the
trochar assembly 50.
[0054] A third embodiment of the safety-stop-device 110 is illustrated in Figure 9. Here
the upstanding member 13 on the base 12 is not threaded. It has one or more vertically
disposed slots 16 and may, but need not, have a collar 22 at the top of the upstanding
member 13 to aid in retaining the clamp 20. In operation, the clamp 20 generally is
first placed on the trochar tube 54 followed by the base/upstanding member unit 12,
13 through the base channel 14.
[0055] Once the unit 12, 13 is slid on the trochar tube 54 where desired, the clamp 20 is
placed over the upstanding member 13 and secured thereover. Any suitable clamping
device will suffice. As illustrated in Figure 9, an over-center clamp 20, with lever
24, is utilized because of its ease of use to lock and unlock the clamp 20. Simply
moving the lever 24 in the direction of Arrow C tightens the clamp 20 over the upstanding
member 13, and squeezes the upstanding member 13 tightly on the trochar tube 54. The
slots 16 in the upstanding member 13 cause the upstanding member 13 to be more flexible
and, with the pressure of the clamp 20, cause the upstanding member 13, as with the
slots described in the previous embodiment, to tightly hold the trochar tube 54.
[0056] The base 12 in any embodiment may be round, as illustrated in figure 9, or may have
one or more side wings, as illustrated in Figure 8, or may bear any geometric shape
suitable for the intended purpose;
i.e., to be a stop member. The safety-stop device 10 may be made of any suitable materials,
including, but not limited to plastics.
[0057] A variation to the first preferred embodiment described above relative to Figures
2-5 [with insert 40] and Figures 6-8 [without insert 40] is currently illustrated
in Figures 10 and 11. The basic structures described above, components, and functions
are typically the same for this safety-stop device 210 with the difference being the
plurality of wings 212 comprising the base component as opposed to the relatively
oval base component of Figure 8 or relatively round base component of Figure 9.
[0058] Figure 10 illustrates this safety-stop device 210 on the cannula 54 with its upstanding
threaded member 13 exposed;
i.e., without the cap 30 thereon. Though so illustrated, this safety-stop device 210, as
mentioned above, does have the same components as the other embodiments and functions
in the same manner. Figures 10 and 11 illustrate 3 wings 212 forming the base component,
though there could be more. Three however have been found to accord the stability
envisioned of this type base component and its functionality.
[0059] The wings 212 generally are equally spaced around the axis of the base component.
In this regard, where the base component has three such wings 212, they are spaced
approximately 120° are spaced approximately 90° apart from each other.
[0060] As described above, once the trochar has penetrated the body and the cannula 54 inserted
a passage has been formed by way of the cannula 54 for insertion and use of various
surgical implements. For this purpose, the cannula 54 must be held steady with minimal,
or preferably, no movement. The base component structures being relatively oval or
round, though suited for the intended purpose, do not accord maximum stability.
[0061] It has been found that a base component with three or more wing structures 212 accord
greater stability of use. Moreover, the apertures 214 adjacent to the ends of the
wings 212 accord the user even greater stability. With the safety-stop device 210
held firmly in place, a user sutures the base component to the patient through the
apertures 214. Once the base component is secured to the patient, the user or the
user's assistant is not required to manually hold the base component firmly against
the patient. This thereby frees a hand for additional assistance and further provides
for an extremely secured attachment.
[0062] It has been found that a thermoplastic material or a thermoplastic rubber material
is best suited for the construction of the base 12, 212 and the wings in any embodiment
illustrated herein. This construction for the base 12, 212 and wings gives them a
greater pliability thereby affording a user greater flexibility for placement and
use of the safety-stop device 10, 210. Depending on where a trochar is to be used
on a patient, angling of the safety-stop device 10, 210 may be necessitated. The pliability
of the base 12, 212 and wings, due to the materials of which they are composed, facilitate
placement, angling, and safe and more exacting use of the safety-stop device 10, 210
and trochar attached to it; particularly in areas which are difficult to access.
[0063] Figures 12-19 are in accordance with the present invention and apply to yet another
embodiment of the same or similar components as described above and as applied to
an entire safety-stop trochar device and system. Key features to this safety-stop
trochar device and system include a smoke evacuator, drainage tube, obturator, dome
light illumination, adhesive on the bottom of the base, and U-shaped extensions on
the cap to be now described in detail. Also the angling of the insert 140 and the
angling of the lower section 135 of the cap 130 have been inverted. Other differences
will be set for and fully described below. 16
[0064] Figure 12 illustrates the 212, as described above, with the addition of the adhesive
material 219 on the underside thereof. This form of base 210 with wings 212 and adhesive
219 is designed to allow the surgeon a variety of methods to stabilize the safety-stop
trochar device/system at right angles to the body through the use of any form of adhesive
suited for the intended purpose, such as, but not limited to double sided adhesive
attached to the underside
[0065] It should have a releasable liner in the event the surgeon elects not to use it at
all and may have a split releasable liner so the surgeon can "change his mind" and
use the adhesive after he has the base 210 on the trochar. The adhesive backed wings
212 can actually be made of an adhesive material or made of a durable, yet pliable,
double sided tape, die cut to fit the base 210 with a releasable liner attached thereto.
This feature provides a secure base to which the safety-stop trochar device/system
can be attached to the skin of the patient during laparoscopic surgery.
[0066] Figures 13-15 illustrate the preferred embodiment of the safety-stop trochar device/system
100 of the present invention. The base 110 is not unlike the base 212 previously described
having three flexible extension wings 112 extending axially outward, suture apertures
114 in the extension wings 112, and an opening 124 in the floor 122. The upstanding
member 116 is internally threaded 118 and its inner chamber is substantially perpendicular
to the extension wings 112 and the floor 122 within the inner chamber.
[0067] For reference purposes, the floor opening 122 has a diameter-D1 and the inner chamber
125 has a diameter-D8. The insert 140 of this entire system 100 has a bottom 148 which
is wider than its top 142 with an angled side wall 146 angling downward and outward
as seen in detail in Figure 13. This insert 140 also has a central bore 144 therethrough
from top 142 to bottom 148 and is made of a flexible or pliable material to permit
its compression when the cap 130 is threaded onto the base 110 with the insert 140
seated therein.
[0068] For reference purposes, the top 142 has a diameter-D4, the bore 144 has a diameter-D5,
and the bottom 148 has a diameter-D6 and diameter-D6 is equal to or less than diameter-D8.
As such, the bottom 148 will rest on the floor 122 when the insert 140 is placed into
the inner chamber 125 of the base 110 and the top 142 may be co-planar with the top
of the upstanding member 118 or below that top. Diameter-D4 is approximately equal
to diameter-D 1.
[0069] The cap 130 of this embodiment has been modified from the cap previously described
by the addition of U-shaped extensions 132 to the basic design of the which then allows
the surgeon to attach the device to the trochar without the use of an external implement
such as a wrench or pliers. This feature also allows easier tightening and loosening
of the device around the trochar and facilitates adjusting intra-operatively, if indicated.
It is unobtrusive, easy to manufacture and use, and eliminates the need for an extra
part that can be misplaced.
[0070] The U-shaped extensions 132 are generally on opposing sides and adjacent to the top
of the cap 130. As so structured, an opening 131 is defined with the U-shaped extensions
132. It has been found that such extensions 132, on opposing sides, and protruding
outward substantially will greatly aid the user in fastening and unfastening the cap
130 to and from the base 110; all without the need of an external tool or device.
It has also been found that structuring the extensions 132 as U-shaped with the openings
131 makes the extensions 132 stronger, more durable, and facilitates manufacture.
[0071] The cap outer wall 138, extending substantially downward from its top and U-shaped
extensions 132, is threaded. An opening through the cap from top to bottom consists
of two distinct sections; an upper section opening 134 which is perpendicular to the
cap bottom 137 [and when threaded into the base 110 is perpendicular to the floor
122] and a lower section opening 135 with a top diameter, diameter-D9, and a bottom
diameter, diameter-D3, wherein the bottom diameter is greater than the top diameter.
As such its inner wall 136 is angled downward and outward toward the cap bottom 137
defining a bottom ring. The angled inner wall 136 bears an angle which is approximately
equal to the angled side wall 146 of the insert 140. This configuration facilitates
acceptance of the insert 140 and, due to its flexible characteristics and pliability,
its compression to thereby secure external objects within the insert bore 144.
[0072] The cap 130 height has a mid-point designated as M1 in Figure 13. The upper section
opening 134 extends downward to a point above the cap mid-point M1 and has a diameter-D2
wherein diameter-D2 is approximately equal to diameter-D1 but generally greater than
diameter-D5.
[0073] The angled lower section opening 135 is defined and begins with the top diameter
of it as being adjacent to and immediately below the upper section opening 134 at
a point above the cap mid-point M1. This top diameter, diameter-D9, maybe equal to
or less than diameter-D2 [for illustration purposes only diameter-D9 is shown to be
less than diameter-D2]. The angled inner wall 136 of the lower section opening 135
is angled downward and outward bearing approximately the same angle as the side wall
146 of the insert 140.
[0074] The cap 130 is externally threaded 138 from below the extensions 132 downward to
the bottom ring at the cap bottom 137. This external threading 118 corresponds to
the internal threading 118 of the base 110. The opening in the bottom ring at the
cap bottom 137, the bottom diameter of lower section opening 135, diameter-D3, is
approximately equal to diameter-D6 on the bottom 148 of the insert 140 and is greater
than diameter-D9.
[0075] This structure in this embodiment is completely different as to the U-shaped extensions
132 on the cap 130, threading locations, inverted insert 140, and lower section opening
135 of the cap 130 angled relatively correspondingly to the angling of the insert.
This structure of inverted insert 140 and angled lower section opening 135, with an
external device therein [such as a trochar or other relatively circular external object],
provides greater securing power of the external device. As with the devices of the
previously described embodiments, the insert 140 compresses onto the external device
as the cap 130 is attached and threaded into the base 110.
[0076] A truly unique and novel feature of the safety-stop trochar device/system is further
illustrated in Figures 15-19. Figures 15 and 19 illustrate the base of this system
as described above. The extension wings 112 should be relatively flexible and pliant
with the underside having an adhesive 119 in addition to or in lieu of the suture
apertures.
[0077] The insert 140A as shown in Figures 18A and 18B has a plurality of upper downward
descending slots 146D [top slots] and a plurality of lower upward ascending slots
146A [bottom slots]. Four top slots 146D, equally spaced apart and four bottom slots
146A, also equally spaced apart and in between the top slots 146D are the preferred
embodiment of this insert 140A.
[0078] In Figure 18B the slots 146A, 146D go up and down, respectively, approximately one-half
the distance of the length of the side wall 146, In Figure 18A, the slots go up and
down, respectively, greater than one-half the distance of the length of the side wall
146. The insert 140 as previously described may also be similarly configured of may
be without top slots 146D or bottom slots 146A.
[0079] It is preferred that the top slots 146D are cut relatively perpendicular to the top
142 and run downward approximately one-half the distance of the length of the side
wall 146 and the bottom slots 146A also cut relatively perpendicular to the bottom
1148 and run upward approximately one-half the distance of the length of the side
wall 146.
[0080] Two significant features of this safety-stop trochar device/system include the smoke
evacuator and drainage device each to be used in conjunction with the base 110, insert
140 or 140A, and cap as described above independently and in place of the trochar.
Figure 17 is illustrative of such use with reference character 154, a flexible or
rigid tube or conduit, as partially symbolizing either the smoke evacuator or the
drainage device inserted through the insert 140 and compressed by the insert 140 between
the base 110 and the cap 130 and is described in greater detail below.
[0081] Any conventional smoke evacuator or drainage device suited for the intended purpose
for surgical assistance will suffice. A typical smoke evacuator consists of a hollow
tube or rigid conduit of approximately between 4-6 millimeters in communication with
the peritoneal cavity at one end [inside end] and connected at its outside end to
a conventional suction or vacuum machine with an on-off switch or button to activate
the machine to thereby remove the smoke being generated.
[0082] In practice what is envisioned is placing a rigid or flexible conduit into the insert
bore 144 and down past the floor opening 124 and then fastening the cap 130 onto the
base 110. Generally a flexible hose is then attached to the conduit at one end and
to a conventional a suction machine or vacuum machine.
[0083] If a only a flexible hose is used, then the inside end is placed into the peritoneal
cavity as described above and the other, outside end, is attached to the conventional
suction machine or vacuum machine. The diameter of a tube or conduit as described
above generally should be approximately equal to diameter-D5.
[0084] The purpose of a drainage device is to remove accumulating blood or pus, which accumulates
over a period of time, generally from 1 to 4 days. These drainage devices generally
are sutured to the skin, which is NOT ideal when infection and pus are present, as
is often the case. Our safety-stop device and entire new system 100, with the adhesive
base 119, can secure the drainage devices more optimally and provides a secure base
to which a drainage tube can be attached. It requires only that the safety-stop trochar
device/system be provided with one 1-2 additional inserts 140, 140A with a bore 144
of comparable diameter to fit the common sizes of the various drainage devices.
[0085] In practice what is envisioned is placing a rigid or flexible conduit into the insert
bore 144 and down past the floor opening 124 and then fastening the cap 130 onto the
base 110. Generally a flexible hose is then attached to the conduit at one end and
to a conventional a suction machine, vacuum machine, irrigating device or manually
operated suction bulb.
[0086] If a only a flexible hose is used, then one end [inside end] is placed into the peritoneal
cavity as described above and the other, outside end, is attached to a conventional
a suction machine, vacuum machine, irrigating device or manually operated suction
bulb. The diameter of a tube or conduit as described above generally should be approximately
equal to diameter-D5.
[0087] As previously described, the current method of attaching a drainage devices is insecure
and often un-sterile and can be accidentally pulled out. Many complications occur
because sutures have to be placed in an area of the body that may be contaminated
by pus. For aesthetic reasons, many patients find suture scars undesirable. The adhesive
back 119 of the safety-stop trochar device/system base 110 provides a secure platform
for inserting the drainage device and eliminates the need for stitches when holding
it in place. Our original safety-stop device, in itself is a unique device and the
drainage device was designed to supplement it, as a complete system in a way that
makes it even more unique in it's design and overall function.
[0088] The inclusion of an illumination device and an obturator fill out this complete safety-stop
trochar device/system. The illumination device provides a method by which a light
can be inserted into the peritoneal cavity after a trochar incision. The device can
be corded or non corded (battery powered) and can be positioned exactly where the
surgeon desires all without impeding other trochar entries and eliminates the need
for an extra set of hands to position the base or trochar or laparoscope lighting
system for better placement of laparoscopic surgical instruments. It does not impede
performance of the remainder of the surgery and can illuminate the entire peritoneal
operating field.
[0089] Typical illumination devices suited for the intended purpose include, but are not
limited to a fiber optic cable hooked up to a laparoscope using alternating current
to power the light.
[0090] The inclusion of an obturator provides a method by which a trochar entry can be maintained
safely. The obturator can be inserted into the peritoneal cavity with relative ease
and as unintrusively as possible. It can be made of any plastic, thermoplastic, rubber,
metal, urethane or polymer and can be installed in less than a minute permitting easy
entry for the surgeon to place a scope for a second look and obviates the need for
stitching and un-stitching the incision which is partially healed. It does not impede
performance of the remainder of the surgery.
[0091] Reference is made to Figures 15, 16A, and 16B. With the use of miscellaneous surgical
accessories, such as, but not limited to, the illumination device 160B and an obturator
160A, there is no need for the insert 140. Each device 160A, 160B has a relatively
flat, circular platform 162 with a diameter-D7 and descending downward from the platform
162 are extension members, symbolizing either the illumination device by reference
character 160B or the obturator by reference character 160A
[0092] This extension member, and respective devices 160A, 160B, each have a diameter-DIO
wherein diameter-DIO is equal to or less than diameter-D1 and diameter-D7 is equal
to or less than diameter-D8 but greater than diameter-D1 and is greater than diameter-D3.
The extension member may be rigid or flexible and should, but need not, have a rounded
surface at its distal end. For the illumination device 160B, a powered light is at
the distal end. The powered light may be, but is not limited to, an LED light or any
conventional fiber optic light, suitable to illuminate the peritoneal cavity into
which inserted. The power source may be internal to the device or external to the
device and, in either case, have a control for on-off operations.
[0093] The respective device [illumination device 160B or obturator 160A] is first inserted
into the base 110 through the opening in the floor 122. The platform 162, having a
larger diameter [diameter-D7] than the opening in the floor [diameter-Dl], rests on
the floor 122.
[0094] The cap 130 is threaded into the base 110. With the cap bottom 137 opening having
a diameter [diameter-D3] which is less than the diameter of the platform 162 [diameter-D7],
the floor 137 is tightened down and onto the platform 162 thereby securing the respective
device [illumination device 160B or obturator 160A] therein.
[0095] The present disclosure includes that contained in the present claims as well as that
of the foregoing description. Although this safety-stop trochar device and system
has been described in its preferred forms with a certain degree of particularity,
it is understood that the present disclosure of the preferred forms has been made
only by way of example and numerous changes in the details of construction and combination
and arrangement of parts and method steps may be resorted to without departing from
the scope of the safety-stop trochar device and system. Accordingly, the scope of
the safety-stop trochar device and system of the invention should be determined not
by the embodiment[s] illustrated, but by the appended claims.